Mark Alan Puckett

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

45394 Issued in KY

Practice address

2400 Eastpoint Pkwy
Suite 110
Louisville, KY 40223-4154

Phone

(502) 253-6699

Fax

(502) 253-6670

NPI assigned

Jun 12, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Sports MedicineAlso: Family Practice

Education

University of Louisville School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
• Baptist Health Lagrange Hospital, La Grange, KY, CCN 180138

Merit-based Incentive Payment System (MIPS)

Final score

94.29 of 100Reported as apm

Quality

87.32

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baptist Health Medical Group Inc

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  Medicare reassignment Care Compare group NPD
• Baptist Health Medical Group Inc

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1780961300
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Healthcare System Inc.

  • General Acute Care Hospital
  • Louisville, KY
  • NPI 1265539498
  Care Compare affiliation
• Baptist Healthcare System, Inc.

  • General Acute Care Hospital
  • La Grange, KY
  • NPI 1306925540
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1649430794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 COMMERCE CROSSING, 3RD FLOOR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40229",
            "telephone_number": "502-253-4924",
            "fax_number": "502-489-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 EASTPOINT PKWY",
            "address_2": "SUITE 110",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234154",
            "telephone_number": "502-253-6699",
            "fax_number": "502-253-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "45394",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "KY",
            "license": "45394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100209760",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpuckett8380@bhkydirect.com",
            "affiliation": "N",
            "address_1": "2400 Eastpoint Pkwy",
            "address_2": "Suite 110",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402234154",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpuckett8380@bhkydirect.com",
            "affiliation": "N",
            "address_1": "2400 Eastpoint Pkwy",
            "address_2": "Suite 110",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402234154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eleanor H Puckett, ARNP
• James Cole Puckett, PHARMD
• Jennifer Puckett
• Loretta Puckett, LPCC, LCADC, NCC
• Luke Puckett, D.C.
• Naqueesha Puckett
• Puerto Medical Group PSC
• Alfonso Puerto, MD
• Melissa Sue Puffenbarger, M.D.
• Elise A. Puffer, APRN

• Sports Medicine (Family Medicine) Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Sports Medicine (Family Medicine) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.